The silent crisis of child abuse in the COVID‐19 pandemic: A scoping review

Abstract Background and Aims The global outbreak of COVID‐19 has become an international concern. The lives of children are severely affected by COVID‐19 pandemic. There is evidence of a pandemic impact on violence against children. This scoping review study aimed to investigate the effects of the COVID‐19 pandemic on child abuse. Methods We searched PubMed, Scopus, and Web of Science databases to retrieve related studies. Regarding the recent incident of COVID‐19, the articles were reviewed from 2019 to June 1, 2021. The terms Child abuse and COVID‐19 were used in the precise search technique of each database. The search techniques were created to work with any scientific database that used the keywords given. Results In the initial search of scientific databases, 568 articles were retrieved. After applying the inclusion and exclusion criteria during the screening process, 16 papers were included in the scoping review. Twelve articles have mentioned the increase of physical, psychological, and neglect types of abuse. However, sexual violence has not been reported in any of the articles. Four articles reported a reduction in the incidence of child abuse. Conclusion During the COVID‐19 pandemic, a crisis occurred in the form of an upsurge in violence toward children, since limits made to diminish the virus, in general, increased the danger to children. Numerous factors such as stress, poverty, financial situation, history of violence, school closures, and lack of contact with support organizations contribute to this phenomenon. Social action and support needed is the right of every child in need in this critical situation.

worldwide as of , and more than 6 million fatalities have been documented. 6 COVID-19 pandemic as a new disease has affected many children which caused them to develop inflammatory syndromes, although the severity of symptoms is lower in children than in adults. 7 The disease is asymptomatic 8 in children or with mild symptoms. 9 The lives of children are severely affected by the COVID -19 pandemic, which has led to negative consequences for them. There is evidence of a pandemic impact on violence against children. It is often not exposed, and many children do not receive the support they deserve. 10 Besides, the situation and house quarantines aggravate this issue and may lead to negligence and abuse. 11 Child abuse is, unfortunately, a worldwide issue with long-term harmful implications. Child abuse affects children under the age of 18 and may be perpetrated by their parents, caregivers, or strangers. Physical, emotional, sexual, and neglect are all examples of abuse. Each of these leads to damage to the health, survival, and growth of the child. About 40,000 deaths occur each year in terms of child abuse. 12 The World Health Organization (WHO) warns of an increase in child abuse considering the spread of COVID-19 and home quarantine. Because children have less awareness and access to move out of the home and obtain aid, the problem of child maltreatment becomes particularly concerning in this circumstance. 13 According to studies, parents are the most common perpetrators of violence toward children. 14,15 During the COVID-19 pandemic, the families suffered various economic pressures, restrictions, and lack of access to support services. 16 The pandemic created a situation for people which increased mental disorders and the severity of symptoms. Anxiety was heightened by restrictions on remaining at home and adhering to health regimens. Younger patients are negatively affected by pandemic stress. During this time, the symptoms and severity of mental diseases, particularly obsessive-compulsive disorder in youngsters, rose. 17 COVID-19 caused many children to spend time at home with their parents, 18 and violence against children often occurs in the home and family. 19 Parents and caregivers who lost their jobs as a result of the pandemic are much more negligent of their children.
Children are more likely to be abused at home as a result of these changes and extreme stress, and the bad consequences may last a long time. 20 Job loss is linked to child maltreatment, according to the findings of systematic review research conducted in the United Kingdom. Sexual abuse was shown to be less associated with work and money, but physical abuse was found to be more related to income and employment. 21 During the COVID-19 pandemic, there was an upsurge in child maltreatment, according to evidence. [22][23][24] The COVID-19 pandemic has created problems for families and children that communities were not prepared to deal with it. 25 Regarding the present global environment and the COVID-19 dilemma, it is critical to assess the position of children who are most at danger of violence. This scoping review study aimed to investigate the effects of the COVID-19 pandemic on child abuse. Therefore, various forms of violence against children during the COVID-19 pandemic were examined.

| METHODS
We followed the five-step methodological framework of Arksey and O'Malley. 26 This includes (1) identifying questions of research, (2) identifying relevant studies, (3) selecting studies, (4) extracting data, (5) summarizing, and describing results. Providing the nature and features of research in the field of interest and short duration are among the strengths of this method. It also provides results in a short and accessible way to consumers and makes it possible to identify gaps.
According to Arksey and O'Malley 's framework, our scoping review questions were (1) Has the COVID-19 pandemic affected the incidence of child abuse?
(2) Which type of child abuse has the COVID-19 pandemic increased?
(3) What were the risk factors for child abuse during the pandemic?
We searched PubMed, Scopus, and Web of Science databases to retrieve related studies. Regarding the recent incident of COVID-19, the articles were reviewed from 2019 to June 1, 2021. The search techniques were created to work with any scientific database that used the keywords given. The terms "Child abuse" and "COVID-19" were used in the precise search techniques of each database. Table 1 shows the specifics of the search technique.

| Inclusion criteria
To select the articles, the following inclusion criteria were defined: (1) Articles focused on the impact of COVID-19 on the incidence of child abuse and (2) Included studies were limited to those written in the English language.

| Exclusion criteria
Articles with at least one of these exclusion criteria were excluded: (1) The title, abstract, or full text of the article was not related to the effect of COVID-19 on child abuse, (2) articles not written in English, (3) articles published in the form of an abstract, reviews and editorial papers, reports, working papers, technical reports, books, letters to editors, short briefs, and commentaries, and (4) full text was not available.

| Data extraction
The present scoping review article was performed based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) protocol. The PRISMA flow chart of the article selection process is presented in Figure 1. To manage citations, retrieved articles were entered into the Endnote X7 library, and duplicates were removed. To discover possibly relevant papers, the two writers individually participated in each article review process (screening, eligibility, and inclusion).
According to the inclusion and exclusion criteria, they assessed the titles and abstracts of all non-duplicated papers. Then, if the articles were unclear or differed upon, they screened the whole text of the articles and addressed the issues with the third reviewer through dialog or consultation. The entire text of relevant papers was then retrieved and examined in accordance with the final inclusion criteria. After the final review of the articles, the following data were extracted from the included studies: authors, year, country, journal, increased violence, risk factors, measures, type of study, sample size, and results.

| Study selection
In the initial search of scientific databases, 568 articles were retrieved: Web of Science = 148, PubMed = 157, and Scopus = 263 articles. First, 280 articles were deleted in terms of duplication. Articles were first studied based on the title and abstracts. Then, 216 articles were discarded due to irrelevance. After applying the inclusion and exclusion criteria during the screening process, 16 papers were included in the scoping review.

| Study characteristics
A summary of general specifications for the studies included in Table 2 is provided. We categorized the findings based on the distribution characteristics of the articles as follows: 4 | Characteristics of the articles

| Country
Based on the findings of this article, 10 articles were conducted in the United States and two articles were performed in Singapore. The other four studies were conducted in China, Egypt, Germany, and India.

| Year of publication
As we can see, among the 16 articles published, 10 articles were published in 2020, and 6 articles were published in 2021.

| Publisher journal
Based on the findings, 43.75% of the total articles were published in the journal of Child Abuse and Neglect. The remaining articles were published in other journals.

| Risk factors
In 25% of the articles, parental stress was mentioned as the main factor in the incidence of violence against children. Household employment status, job loss and income, food poverty, the number of children in the family, the age of the children and parents, and a history of violence were all risk factors.

| Measures
The majority of articles (56.25%) were done through online review and 43.75% through related data analysis.

| Type of study
According to the findings, 62.5% of the articles were cross-sectional and the rest were longitudinal or retrospective.

| Sample size
Details of the sample size are given in Table 2.

| Results
The The reporting of abuse was hindered during this time of quarantine owing to a lack of contact and access by children to centers, schools, or relatives and acquaintances. 40,41 According to a study by Seddighi et al., violence such as physical violence, neglect, and abuse increases after many emergencies and disasters, which is much more common than usual. In this area, child caretakers, particularly parents, have been highlighted as a key source of violence toward children. 15 Children are more likely to be abused following natural catastrophes such as earthquakes, hurricanes, 42 and wars, according to research. 43,44 Reports indicate that children are more likely to be abused in pandemics, such as Ebola 45,46 and the risk of domestic violence increases in terms of the pressures on families resulting from the crisis. 45 According to the results of Campbell, decreased reports of child abuse during the pandemic are due to fewer opportunities to identify cases. 11 According to the WHO, children are less likely to obtain assistance since they are unable to leave the house, and their young age makes them unaware of available resources. 8

| LIMITATION
The lack of extensive studies on violence against children during the pandemic was one of the limitations of this study. Therefore, the lack of reports of a decrease or increase in violence and the type of violence in some articles made it difficult to investigate the crisis.

| CONCLUSION
COVID-19 pandemic crisis itself, created a new crisis in many societies. Although child abuse often goes unreported, we must believe that the crisis has intensified in recent months. 10

ACKNOWLEDGMENT
This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.